Spleen

The spleen is an organ located in the upper left side of the abdomen, tucked under the rib cage, behind the stomach. It is normally about the size of a person’s fist. The spleen produces antibodies and filters bacteria from the blood. This helps the body to fight infections.

Risks of a Non-Functioning Spleen

People who had their spleen removed, or underwent high-dose radiation to the spleen (30 Gy – 3000 cGy/rads or higher) have a greater risk of developing serious infections. The types of infections most likely to occur in people without a functioning spleen are caused by encapsulated bacteria (germs with an outer coating that protect them from the body’s immune system) and include Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria (meningococcal meningitis).

Signs of Infection

Fever is a sign of infection. Often, fever is caused by a virus (like the flu) and not by dangerous bacteria. However, there is no way to know if bacteria are the cause of a fever unless a blood culture is done. Unfortunately, it takes anywhere from a few hours to a few days for the blood culture results to become available. Therefore, whenever you have a fever you must be treated with antibiotics as if you had a serious infection, at least until the results of the blood culture is known.

Other symptoms of infection include unusual tiredness, muscle aches, chills, headache, vomiting, diarrhea, and abdominal pain. These symptoms can be warning signs of infection even if you do not have a fever. People at risk for infection should check with your healthcare provider if they develop these symptoms and should take their temperature regularly when ill.

In Case of a Fever

If your temperature is 101°F (38.3°C) or higher:

Seek immediate medical attention (even if you are taking antibiotics).

Tell your healthcare provider that you do not have a functioning spleen.

Report any symptoms that you are experiencing (such as those listed above).

Receive a strong antibiotic (by injection into a vein or muscle), at least until the blood culture results are available.

Preventing Infection

Vaccines – Vaccines may reduce the chances of a serious infection. Patients without a spleen, or with a damaged one, are recommended to receive the Pneumococcal, Meningococcal, and HIB (Haemophilus influenzae type B) vaccines. Everyone should have at least one booster of Pneumococcal vaccine, given 3 to 5 years after the first shot. Some healthcare providers recommend additional boosters. Many healthcare providers also recommend yearly influenza (flu) vaccine to reduce the risk of bacterial infections that can sometimes occur as a complication of flu.

Antibiotics – Some healthcare providers recommend daily preventive (prophylactic) antibiotic pills, such as penicillin, to try to preventing serious bacterial infections. Others may have patients keep a prescription to have on hand with instructions to begin taking antibiotics at the first sign of illness. Still others may recommend a prescription for antibiotics only if traveling to an area where it will be difficult to obtain medical care. In any case, it is essential that people seek immediate medical attention any time they develop fever, chills, or other symptoms of serious illness. Delaying a medical visit for even a few hours can be very dangerous for those without a spleen or with a damaged one as bacterial infections can worsen rapidly.

Other Precautions

Patients without a functioning spleen are at increased risk for problems with the following infections:

Malaria: Take special precautions to avoid getting malaria when traveling to countries where it occurs by receiving the necessary medications before traveling. During travel, use insect repellants and other protective measures, such as netting and protective clothing.

Dog Bites: Dog bites can result in serious bacterial infections. People who receive a dog bite that breaks the skin should seek immediate medical attention for treatment with antibiotics.

Ticks: People without a functioning spleen are at increased risk for an infection caused by Babesia, a germ transmitted by deer ticks. These ticks are most commonly found in the northeastern United States and in some European countries. (Note: this is not the type of germ that causes Lyme disease). Wear protective clothing and use insect repellants when going outdoors in tick-infested areas. If bitten, remove the tick and talk to your healthcare provider about what to do.

Tell Healthcare Providers About a Non-Functioning Spleen

Be sure to tell all of your doctors, dentists, and other healthcare providers if you do not have a functioning spleen. Wear a medical alert emblem (bracelet or necklace) so if you are unable to communicate in a medical emergency, you will be readily identified as not having a functioning spleen. Carry a wallet card with guidelines for healthcare professionals regarding the management of fever in people without a functioning spleen.